Customizing healthcare: How a new approach to diagnosis, care, and cure could transform employer benefits in a postreform world

Looking into the next decade and beyond, PwC’s Health Research Institute sees three key forces—consumerism, genomics, and the Internet—culminating to usher in an era of truly customized healthcare. Employers that are already grappling with ongoing health reform are beginning to consider how that new healthcare model affects them. In this article, PwC’s health leaders, Kelly Barnes, David Levy, and Sandy Lutz, examine what the new model might look like and how it could change health services, treatment options, reimbursement, performance metrics, payment, and incentives.

Healthcare is fundamentally changing on several fronts. In the US, the big story has been reform. Over the next decade, the new law’s changes to funding, insurance coverage, and regulation will affect virtually everyone—including large employers, the majority of which are self-insured. Proactive companies are already considering how reform will change plan eligibility, plan design, underwriting rules, tax deductions, and more and are reevaluating their benefits strategies accordingly. As they begin to understand how the complexities of the new law affect them, they’re also learning that reform has changed things on a more fundamental level. There’s a renewed emphasis on keeping people well, out of hospitals, and more actively engaged in managing their own health.

Health reform, however, is not the only game changer. PwC’s Health Research Institute has identified an emerging phenomenon not only in the US but also in every major health system around the world: In response to the global recession and to pressure to reduce the rising healthcare costs associated with chronic diseases, government and health industry leaders see both the potential for individuals to take greater ownership of their health and the need for fundamental structural changes in the health system to help them do so.1

We expect that over the next five years, the trend will lead to significant health industry business model changes, more regulatory reforms focused on efficiency and effectiveness, greater investments in prevention, and a growing role for information technology to facilitate information sharing and to provide interactive, customized care in a virtual world.

Remaking the health system—forces at work

Current healthcare models are struggling to keep up as volumes of care become more and more unmanageable. Today, people both old and young are developing chronic diseases in record numbers, in part because diseases that were once fatal are now chronic, draining health resources and increasing health spending while they extend life. At the same time, it is becoming widely accepted that chronic diseases are associated with behavioral, socioeconomic, and genetic factors that the current medical delivery system does not, for the most part, address.

For example, the first force at work involves genetics and the science of personalized medicine. This will bring many changes to healthcare. Scientists working in the field of genomics predict that within the next decade, billions of data points on every individual will exist, as will powerful tools for analyzing that data. From a single drop of blood, clinicians will be able to scan organ systems and determine whether they’re healthy or diseased and what their future status will be. They will also be able to match particular types of patients to particular types of drugs.2 (For a more detailed discussion of personalized medicine, see Personalized medicine.)

Scientists working in the field of genomics predict that within the next decade, billions of data points on every individual will exist, as will powerful tools for analyzing that data.

Another powerful force at work is information technology, which is leading healthcare into a new era of so-called mass customization, following other industries such as auto manufacturing, media, and entertainment. Smart phones, electronic health records, home health monitoring technologies, and treatment architectures are having big impacts, as is data sharing among patient, research, and provider communities.

Together those forces are helping shape a new framework for healthcare—one that is centered on customized care. Everything will change as a result: services, treatments, performance metrics, payment, outcomes, and incentives.

By 2020, we expect to see a seismic shift in the relationship between patients and healthcare systems, with patients residing at the epicenter of care. We have identified five touchpoints around which we believe the new model will be organized. The touchpoints are designed to engage individuals and to transform the ways they manage their health and access information. (See Figure 1.) Following is a brief look at each of the touchpoints— why they are important and how employers can begin to incorporate them into their own health strategies.

1 PwC’s Health Research Institute, HealthCast: The customization of diagnosis, care, and cure, April 2010.